Application to become a dimmer distributor for Futronix

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Company:*

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Name:*

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Telephone 1:*

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Telephone 2:

Email:*

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1. Company

A. PROFILE

1) Are you a:

corporation partnership sole proprietorship

2) How Long has your company been in business:

years

3) What is your current annual turnover? :

B) COMPANY GROWTH PLANS

1) Do you operate on a sales plan & budget?

Yes No

2) Projected 1st year turnover with Futronix? (USD $):

C) MANAGEMENT

1) Is the management active in sales?

Yes No

2) Is the management technically qualified ?

Yes No

2. TERRITORIAL COVERAGE

A) PRESENT LINES REPRESENTED

1) What major product lines do you represent, and for how long?

Product 1:

Period 1:

Product 2:

Period 2:

Product 3:

Period 3:

2) Is there compatibility with Futronix products?

Yes No

3) Is there any conflict with Futronix products?

Yes No

B) TERRITORY COVERED & MARKETS SERVED

1) What territory/s do you cover ?:

3. SERVICE & TECHNICAL

1) Do you have technical/service facilities ?

Yes No

2) How many sales staff does your company employ?

3) How many technical staff does your company employ?

4. REFERENCES

A) PROFESSIONAL MEMBERSHIPS

1) Are you or your company members of any professional organisations? How long?

B) BANKING

1) Please list your main banking facilities:

ADDITIONAL INFORMATION ATTACHED TO THIS FORM

Insert here any additional information regarding the above questions.

Please attach any further documents in support of your application

1) company history, resume or brochure

Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 1mb.

2) resumes of management and technical staff

3)Details on possible conflict with existing product lines

4) References from key accounts.

Thank you for completing this form

Futronix Dealer Application Form

Please fill this form in to become a Futronix dealer

1. Company

2. TERRITORIAL COVERAGE

3. SERVICE & TECHNICAL

4. REFERENCES

Buy Futronix dimmers, LED lamps and Lighting controllers online